'There's No Such Thing as Society'. The Moral Tyrannies of
Therapy

Talk given at the SCOS annual conference on 'Organizations,
Institutions and Violence', Dublin, July 2001

There can, surely, be no disputing the observation that present day global
society is neither just nor equitable. It is, in fact quite spectacularly
unjust and inequitable, and apparently becoming more so.

One of the central tasks of modern 'governance' is to keep this fact from
reaching and lodging in the forefront of our minds. In this enterprise it is
extraordinarily successful, and is also apparently becoming more so.

Distributed throughout developed, Western society there is, as Foucault put
it, an apparatus of power now all but perfected in obscuring from the vast
majority not only the extent of injustice and inequity globally, nationally and
locally, but also the ways in which injustice and inequity cause
suffering.

Somewhat idiosyncratically, I fear, I see it as the role of clinical
psychology to work away at demystifying one small aspect of this apparatus:
i.e., to try to explicate the link between malign societal influence and the
subjective experience of distress.

It has been the achievement of people like Michel Foucault and Christopher
Laschamong many others, of courseto show that we are no longer
necessarily socially disciplined by violence so much as by the
engineering of acquiescence and consent; even by the manipulation of pleasure.
If it appears that I am stretching conventional meanings in associating much of
what passes for psychotherapy and counselling with violence, I hope, then, it
is apparent that I am doing so in the now well established Foucauldian sense of
therapy as, so to speak, Ersatz violence.

As it has developed over the last hundred years, therapy has become one of
the principal ways in which social injustice and inequity have managed to
obscure their consequences. For, at least by implication, therapy maintains
that there is no such thing as society, only individuals and their
families. Margaret Thatchers notorious dictum could well be adapted as
its slogan.

Just consider what the 20th century brought forth in the way of explanations
of and treatments for emotional and psychological suffering:-

Organic psychiatry. Confronted by the distressed and confused, the
desperate and the dazed, by people at one extreme driven out of their minds by
wretchedness or at the other perhaps just cautiously trying to interpret and
manage their sense of dread, psychiatry studiously ignores everything they have
to say (explicitly or implicitly) about the world, and instead pokes around
inside their bodies looking, for example, for unusual neural, chemical or
genetic structures. Psychiatrists have been doing this resolutely for well over
a hundred years without yet coming up with any explanatory formulae that
satisfy any scientific group other than themselves. Psychiatric critics who
have developed alternative viewsas for example R.D. Lainghave, if
they cannot be ignored, been marginalized and ridiculed.

Psychoanalysis. Not only did Sigmund Freud , as Jeffrey
Masson1 so ably demonstrated, back away from
his first tentative observations of the essentially social origins of so-called
hysteria, he promptly thereafter tucked away virtually the whole of
psychopathology in a mysteriously inaccessible moral realm deep
within a metaphorical interior space. In this moral realm were
packed all the deadly sins, plus the means of their redemption, plus the
apparatus for transforming evil into good, unreason into reason. What went on
in the outside world was a matter of supreme indifferenceFreud even
forbade his patients, so far as they could, to have anything to do with it.
Despite laser-sharp critiques like that of Ernest Gellner2, the extraordinary structure which psychoanalysis
became proved a huge hit with the Western capitalist world, and shows little
real sign of wavering even now (though why should I say even now,
when unreason appears to have entered a new heyday?).

Humanistic therapies and counselling. The boom in
therapeutic approaches that got under way about mid-century and has flourished
so successfully since, inspired largely by Carl Rogers but with the assistance
also of many a lesser guru, has at its heart the notion that personal salvation
lies in the hands of the individual him or herself. The origins of distress lie
in personal experience, and the solutions to it in the willingness of sufferers
to take responsibility in one form or another for their predicament
and, ultimately, will the necessary changes to their way of life. We
are, according to the philosophy of modern therapy, autonomous, self-creating
individuals whose emotional pain is, when all is said and done, a matter of
choice.

Cognitive-behavioural approaches. These form the core of a new
scientistic theology which is supported by a strengthening doctrinal orthodoxy
and an increasingly confident scholastic authority. Volumes of research into
the effectiveness of psychological therapies, the product of decades of
academic and clinical industry, lead to the in my view inescapable conclusion
that there is no convincing, consistent or significant evidence for the
technical effectiveness of any current therapeutic approach to psychological
distress. This body of evidence is magisterially overlooked by the doctors of
cognitive-behaviourism, who, with unblinking authority, cite instead the
handful of research efforts that can be mustered to demonstrate the
effectiveness of their approach. At the centre of this creed is the idea that
the kind of human suffering that brings us to the psychological clinic is the
result mainly of dysfunctional thoughts and mis-attributions as to
the real reasons for our troubles. The glass is not half empty, but half full,
etc. Once again, no sign of society.

The environment in which therapy works ca be summed up like this:-

In this environment of the consulting room, consideration of society extends
as a rule no further than to the people inside the patients head (though
there are approachese.g. systemic onesin which some of
these figures do actually materialize in the room itself).

So deeply imbued are we with the autonomous individualism of twentieth
century psychology that to question its accuracy is to risk apostasy from
intellectual and moral probity. For it forms the heart not just of our approach
to emotional distress, but is deeply rooted also in the wider culture: in
literature, in art, in the almost unshakeable commonsense understanding of self
that seems to underpin the experience of every one of us. Do we not run our
lives by assessing our situation and making choices? Is not our daily
experience one of the almost continuous exercise of freedom? Is it not
self-evident that the answer to psychological unease must in one form or
another be one of self-adjustment? Surely such a view is the very antithesis of
tyranny.

In fact, I think, this view is informed more by a magical wishfulness than
it is by any sober assessment of our condition. What seems common sense can I
think better be understood as a highly misleading ideology that, though no
doubt growing away quietly in previous centuries, has come to full bloom over
the past hundred years and that, though it is most fiercely defended by those
it most effectively enslaves, truly serves the interests only of those who
profit most from the way our society is ordered. In fact, I submit, we
do not as ordinary people to any significant extent choose the
conditions of our existence, and when, as we often do, we find that they hurt
us, our ability to change them is very strictly limited. The apparent moral and
epistemological autonomy that we mistakenly take as definitive of our very
humanity helps to blind us, I think, to the societal factors which in fact very
largely control our lives and our experience. We are, if you like, held in
place by a largely invisible tyranny. One of the few places the workings of
this tyranny come to light (to the critical eye) is in the psychological
clinic.

Having spent my working lifetime in the British National Health Service, I
have found that only a minority of patients enter my office feeling themselves
subjectively the moral equal of their peers. In addition to the distress that
brings them there, most people are apprehensively expecting to be
judged. This, when you think about it, is an unusual state of affairs
for someone consulting a professional adviser. For example, even though you
expect a lawyer to be wiser than you in the ways of the law, you do not
anticipate when consulting one that you will be treated as a morally inferior
being, and any lawyer who treats clients as such is unlikely in the long run to
prosper.

But not only do clients of therapy often expect to be treated as
morally inferior, as a matter of fact they often are so treated. For a
start, the whole therapeutic enterprise is built on an assumption of
abnormality. The patients conviction that there is
something the matter with me is unlikely to be questioned by anybody he
or she encounters in the clinic. But beyond this, the feelings patients often
express, once theyve spilled their beans, that I know its
me, I know nobody can do it but myself, etc., reflect
perfectly accurately the common therapeutic view that
responsibility for their cure lies in their own hands. Because,
after all, they are free agents. Once the therapist has done the job of
demonstrating to clients the errors of their conscious and unconscious ways,
its then up to them to switch on their agency and do
something about it. If they dont, they must be succumbing to an attack of
resistance, evincing inadequate personality or some
such.

Even the somewhat sanctimonious Carl Rogers, with his quasi-religious belief
in the essential goodness of the human soul, and despite his emphasis on
therapeutic warmth, empathy and genuineness, placed a huge moral
burden on the shoulders of his patients, for he left them with nowhere to look
for the cause of their problemslet alone the curebut in the
recesses of their metaphorical psychological insides.

This kind of moral judgmentalism, which pervades psychoanalytic as well as
pretty well all so-called humanistic brands of therapy, leads
quickly to a corresponding aesthetics of human being which is equally if not
more oppressive. For captaincy of ones own soul gives one admission to an
exclusive club of the Chosen Ones of therapy: whether as fully
analyzed, individuated, self-actualized, etc.
These are the celebs of the psychotherapeutic world, and inability to gain
entry to their club can become a matter for continuous self-reproach.

What, in my view, most clearly exposes the nonsense of this therapeutic
moralism and aestheticism is, paradoxically perhaps, the experience of the
practice of therapy itself. Theory and practice contrast in the following
ways:-

Theory suggests

Clinical experience
teaches

Insight leads to change

We are not in control of our conduct; therapeutic change is
not demonstrable

People may assume responsibility

There is no such thing as will power

Thought (cognitions) leads to action
(behaviour)

The causes of our conduct are frequently mysterious, and
rationally unalterable

Patients conduct is controlled by more potent
influences in their social environment

It seems to me that the only way we can resolve these difficulties is by
bursting out of the consulting room and taking proper account of what goes on
in the wider society. Something along these lines:-

In concerning itself as it has and does almost solely with what I have
indicated here as the realm of experience, in which it locates all
its causal as well as its phenomenal investigations, psychology cuts
itself off from understanding the origins of our troubles, and limits us to a
conceptual language that suggests in the end (or in Freuds case more in
the beginning) that all that befalls us is spun out of our imagination and our
cognitions. For there is simply nowhere else to look, nothing else
to talk about. To restrict someone who is struggling to understand their
suffering to the concepts and language of experience is indeed a
kind of tyranny.

Take the example of a very intelligent young woman who periodically starves
herself and/or cuts her arms and legs with razor blades. Everyone around
herfamily, boyfriends, doctorsinsist that a) what she does is
abnormal and pathological, and b) that at least potentially she should be able
to give an account of why she does it. As things are, she absolutely cannot
understand why she does it; she just knows that when she does, it
helps, it gives relief to distress, it doesnt feel wrong. She is of
course aware of cosmetic drawbacks, etc., and is not exactly surprised that
others react with various degrees of shock and horror. But she is oppressed
above all by a sense of moral failure which is conveyed to her by just
about everyone. Every time she succumbs to the urge to cut, for example, just
about the worst aspect is the sense of moral defeat and disapproval. She has
let everyone down, and by extension, of course, let herself down.
At times when things are going well and she feels reasonably happy, the dread
of possibly letting herself down in the future still hangs as an
ominous cloud on her horizon.

She has read all the books and considered all the theories, but oh, if only
she could understand!

She has had quite a lot of attention from various professionals, some of
whom have been more helpful than others, and the consulting room environment
has been thoroughly scrutinised, including her perceptions of her family
background. Despite clear awareness of (insight into) difficulties
in her family life which contributed to the causes of her unhappiness, she is
still no further on with understanding her actions. The only conclusion she can
come to is that she is simply morally inadequate in some way that is far from
clear to her.

Now I hope you are not anticipating that I am going to pull out of the hat
some magical solution to this puzzle. I cant do that. What I do want to
do is raise some questions about why this young womans predicament
is such a puzzle, and why we have to oppress her with the demand that
she understand it within the psychological terms we insist on
restricting her to.

One of the first things to note is the narrowness of the sphere in which we
permit ourselves and her to conduct the investigation. It is outside social
space-time. That is to say, it is both an essentially private realm and one
that has no historical dimension. If we introduce public space and history into
our considerations, the picture does indeed change a little. In other times,
for example, mortification of the flesh, fasting and self-starvation have not
only been familiar exercises of religious discipline, but have been positively
admired by those too spiritually weak to embark upon them themselves. In other
places, furthermore, many other young women are doing exactly as our patient
does. She is not in fact caught up in purely idiosyncratic acts of
self-destruction, but is one of hundreds of thousands (at least) of people
doing exactly the same kind of thing.3

Hers, I would argue, is a social response to a social predicament. Our
demand for an explanation in terms of private, internal motivation is in fact
quite a strange and unusual one, and our response, I would suggest, is,
unintentionally no doubt, a singularly punitive and unhelpful one.

First, the demand for an explanation. Though, Im sure, we would have
questions to ask, I think most of us would allow a degree of self-evidence to
the actions of the religious mortifiers of the flesh which we are not ready to
permit our young woman. (In the same kind of way, we insist that the
obsessive-compulsive is suffering from a psychological
disorder, but we allow religions their superstitious rituals
without turning a hair.) We do not, in other words, feel we have to extort an
explanation for what people do when they do it in concert with others. Somehow
we feel we know what theyre up to. When they do it on their own, we are
more likely to accuse them of madness or badness.

Second, the reaction. Therapy can all too easily become the
worst kind of clinical gaze: relentless, penetrating, insistent, covertly
judgmental. What might be a more appropriate reaction to the sufferer?
Sympathy, comfort, affection, practical help. In a word, compassion. Anyone can
do that.

If we are to arrive at a more adequate account of how emotional distress and
psychological suffering come about, and to formulate more appropriate responses
to it, we are, I believe, going to have to re-introduce society into the
picture and develop a set of conceptual tools that accommodate better than does
the language of interior psychological space the difficulties revealed by
(among other things) the experience of therapy.

The challenge for this enterprise is to give a societal account of the
origins of distress which neither sacrifices individual subjectivity to some
kind of collective ideal nor violates the sense that each one of us finds so
compelling of the reality of human agency. Let me end by giving a very brief
and inadequate indication of the kind of thing I mean.

Just going back to my last diagram:-

Power is generated within and through social institutions. The institutions
of power operate independently of particular individuals and at varying
distances from them, affecting them via almost unimaginably complex lines of
influence that travel through individuals as well as through other
institutions. The further away from the individual person a particular social
institution is, the more powerful it is likely to be and the more individuals
it will affect. For example, the machinery of global capitalism has enormous
effects on vast numbers of people in the world who are themselves in no
position to be able to see into its operation.

The extent to which an individual can be said to have power will
depend upon the availability to him or her of power within the system,
i.e. how much power is transmitted through him or her from outside
sources. The diagram gives the impression that power flows only in one
direction - from the more to the less powerful. This is of course somewhat
misleading: it is possible both for proximal to influence distal institutions
and for individuals to act back onto their environment. It is however the case
that the flow of influence in this 'reverse' direction is strictly limited in
scope and distance.

I suggest that an individual might in this way be defined as an embodied
locus in social space-time through which power flows. People are held in
place within the social environment by the influences which structure it, and
their freedom to change position or influence people and events is strictly
limited by the availability of power within the sub-systems in which they are
located. In fact, no significant amount power is available to the
individual beyond that which is afforded by the social environment either now
or in the past.

In this diagram Ive attempted to indicate some of the complexity
involved in all this. A family floats in social space, the direction of
influence between its members and some proximal systems shown by the arrows and
its relative strength by their thickness. Rather as if each of the smaller
spheres were like a neuron or system of neurons in a nervous system, the
electrical impulse of conduction is power and the
neurotransmitter is interest. But the diagram leaves out infinitely
more than it can illumine. Quite apart from the different ways in which power
can engage or coerce interest, it is impossible to convey the way it flows
through the system. Power does not originate within the individuals, nor
evento any significant extentwithin the institutions shown (e.g.
work, school), but is generated much more distally within and between
socio-economic and cultural systems whose all-pervasive influence defies
intricate analysis.

What, then, of our sense of agency? Am I not putting forward here a
determinist view that has all sorts of depressing implications for freedom and
the independence of the human spirit, etc.? There are just two points I want to
make about this.

The first is that I am not denying freedom, but I am suggesting that we are
free to do only that which we have the power to do. Much of the time we have
very little idea about what is in our power to do and what isnt, and in
this regard therapy and counselling are not only particularly deficient, but
downright misleading and oppressive.

The second point is that much of our sense of agency follows necessarily
from our nature as embodied creatures. As social powers and influences
flow through us, we have an irresistible feeling of their originating
within us, because that is all we could feel. We attribute all
kinds of significance to our feelings in this respect, and to account for what
we feel ourselves doing, we invent a language of autonomy and responsibility
that does not in fact stand up to critical examination and analysis. If we want
to understand what we are up to and why we suffer, we are going to have to pay
far more attention than we have in the past century to the structure and
dynamics of social space-time.

1 Masson, J.M. 1985. The Assault on Truth. Harmondsworth: Penguin
Books.
2 Gellner, Ernest. 1985. The Psychoanalytic Movement. London: Paladin.
3 At the time of writing this I had not come across The Language of Injury.
Comprehending Self-Mutilation by Gloria Babiker and Lois Arnold (1997,
Leicester: BPS Books). This is in many ways a model work of clinical
psychology, placing as it does the individual experience of self-injury within
the broader cultural and historical context. The book is likely to be most
helpful to anyone interested or involved in self-injury.